Hospital Topics

Part of the value of CHA membership lies in the deep expertise available to member hospitals and their employees. CHA has created and gathered up-to-date information on the topics most relevant to hospitals, patients and communities. When logged in, members can access a vast array of information about clinical care, financial matters, government reimbursement, information technology, human resources, legal representation, facility maintenance, patient safety and more.

Part of the value of CHA membership lies in the deep expertise available to member hospitals and their employees. CHA has created and gathered up-to-date information on the topics most relevant to hospitals, patients and communities. When logged in, members can access a vast array of information about clinical care, financial matters, government reimbursement, information technology, human resources, legal representation, facility maintenance, patient safety and more.

The California Department of Public Health (CDPH) Licensing and Certification surveyors may visit a hospital at any time to determine whether the hospital is in compliance with state licensing requirements. Visits may result from a complaint by a patient, employee or other third party; a newspaper article; or a report by the hospital itself regarding an unusual occurrence, privacy breach or adverse event.

The California Department of Public Health (CDPH) has issued the attached All Facilities Letter noting current outbreaks of hepatitis A infection in San Diego and Santa Cruz counties. According to CDPH, infections are particularly prevalent among homeless persons and users of illicit drugs. CDPH has determined transmission occurs person-to-person; no commercial product is identified as being contaminated.

CDPH recommends that hospitals work with local health departments to offer hepatitis A vaccines to all patients who are homeless, users of injection or non-injection illicit drugs, infected with hepatitis B or hepatitis C, or have other liver disease. Hospitals must contact their local health department immediately – while the patient is still in the facility – to report suspected hepatitis A infections, as well as promptly report all confirmed cases and save the blood (serum and EDTA or citrate plasma) from hepatitis A serological testing. Providers in outbreak jurisdictions should also make the hepatitis A vaccine available to health care personnel who have frequent close contact with patients who are homeless or use illicit drugs.

The California Department of Public Health’s Center for Health Care Quality will host its semi-annual stakeholder forum on Aug. 17 from 1-2:30 p.m. (PT). The forum is scheduled to provide updates on Licensing & Certification Program activities, including a performance metrics update, Hubbert recommendation updates, and discussion of 3.5 staff direct care hours regulations as well as the Quality Accountability Supplemental Payment Program. The session will also include time for general questions and answers. More information is available on the Stakeholder Forum web page.

If a symptomatic patient has no identifiable Zika exposure, providers should contact their local health department. Providers should remind patients who want to conceive in the near future, and who have an ongoing risk of Zika exposure, of recommendations to delay pregnancy until exposure can be reduced. Preconception patients should also consider immunoglobulin M testing to establish a baseline to inform future Zika test results, should the patient be exposed in an ensuing pregnancy.

The California Department of Public Health this week launched its redesigned website, including improvements to the Center for Health Care Quality’s Licensing and Certification Program pages. The site aims to highlight the work of public health and promote the department’s protection of California health and wellness. The old site, which has been archived and will be taken down in the next few months, is available at https://archive.cdph.ca.gov/Pages/DEFAULT.aspx.

The California Department of Public Health (CDPH) has issued the attached All Facilities Letter updating its previous guidance related to reporting emergency and disaster occurrences that threaten the welfare, safety or health of patients. The updated guidelines provide contact information for reporting an emergency that results in patient evacuation, transfer or discharge. During normal business hours, facilities are reminded to report to their local CDPH Licensing & Certification district office. After hours, or if the district office is non-operational, facilities should contact the Office of Emergency Services Warning Center or, if in Los Angeles County, the Los Angeles County Operator.

Health care is undergoing tremendous change and uncertainty as California implements the federal Affordable Care Act (ACA). Hospitals are working to ensure there will be enough beds and an adequate supply of health care professionals to meet the demands of the millions of Californians who are signing up for health insurance coverage under the ACA. In addition, California hospitals are meeting the needs of their communities through locally developed community benefit plans by supporting health care programs that provide preventative care to those in need.

Tax-Exempt Status of Nonprofit Hospitals

The tax-exempt status of nonprofit hospitals is being reviewed by policymakers, regulators and public interest groups. There are various proposals to impose burdensome and inflexible standards on nonprofit hospitals in order to obtain tax-exempt status and financing. CHA supports the development of appropriate guidelines that are not unduly burdensome and will allow sufficient flexibility to ensure nonprofit hospitals are able to carry out their mission. They must be based on broad measures of community benefit without establishing rigid formulaic thresholds.

CHA has released the attached educational brochure highlighting California’s community benefit history. For more than 20 years, California’s not-for-profit (NFP) hospitals have led the nation in ensuring that vulnerable populations have access to much needed health care services and health improvement programs. Each year, they contribute an estimated $12 billion to their communities through community benefit programs and activities, including mobile units serving disadvantaged families, classes on disease management and violence prevention, health professions education programs that train the next generation of health care providers, research in clinical and community health that contributes to evidence-based practices, leadership development and training for community members, and much more.

The brochure highlights the ways NFP hospitals partner with their communities to assess community health needs, and explains why flexibility in program development is critical.

Clinical care touches every aspect of hospital operations. Policies and procedures surrounding clinical care are of the utmost importance in meeting regulatory, legal and licensing requirements. CHA has numerous area-specific groups — including specialty centers and committees — that address the many aspects of clinical care. Some areas of clinical care are subject to rapid changes in public policy and regulations, creating additional challenges for hospitals. In addition to providing representation and advocacy to address these challenges, CHA focuses on the unique needs of certain facilities, and the services and programs they offer their communities.

The Centers for Medicare & Medicaid Services (CMS) has posted resources from its recent webcast training on post-acute care quality reporting program (QRP) review and correct reports. Among the resources are a video recording and post-training materials, including a question and answer document. The materials are accessible on the CMS QRP training pages for inpatient rehabilitation facilities, long-term care hospitals and skilled-nursing facilities.

Special resource toolkit developed by CHA’s EMS/Trauma Committee and the Center for Behavioral Health. Designed to help staff provide support to patients in the ED with psychosis and/or substance abuse disorders, this toolkit provides access to articles, policies, management techniques, assessment tools and more. Click the topic tabs below to access resources and information.

The End of Life Option Act is one of the most important bills the Governor signed into law this year. Individuals who have a terminal illness and meet certain qualifications may now ask their physician for prescription medication to end their life. The law is complicated and not without controversy.

Overview

Whether you are a sending or receiving hospital, many factors must be considered when dealing with a potential EMTALA situation. Knowing the right thing to do isn’t easy, especially in a stressful or busy emergency department.

The Centers for Medicare and Medicaid Services (CMS) has issued the attached memo reminding health care providers of requirements for fire and smoke door annual testing. Under the 2012 edition of the National Fire Protection Association (NFPA) Life Safety Code, facilities must meet certain requirements for the maintenance, inspection and testing of fire doors and smoke doors in certain certified health care facilities. In health care occupancies, annual inspection and testing in accordance with the 2010 NFPA 80 is required for all fire door assemblies. Although non-rated doors, including corridor doors to patient care rooms and smoke barrier doors, are not subject to those requirements, they should still be routinely inspected as part of the facility maintenance program. Facilities were originally required to comply prior to July 6, 2017. However, due to reported misunderstanding of the requirements, CMS has extended the deadline for full compliance to Jan. 1, 2018.

The Office of Statewide Health Planning and Development (OSHPD) asks health care providers to complete a one-question survey on its policy intent notices and code application notices. Information received will help OSHPD develop an educational webinar series and identify which notices should be included in the webinar. The survey must be completed by Aug. 18.

Last month, the Office of Statewide Health Planning and Development moved to a new location. Its headquarters are now at 2020 West El Camino Ave., Sacramento, CA 95833. Email addresses and phone numbers remain the same. Effective immediately, Hospital Building Safety Board (HBSB) meetings have also moved to the same location; details are available on the OSHPD website.

Overview

Effective January 2017, hospitals that perform sterile compounding must meet new regulatory requirements from the California State Board of Pharmacy. Beyond updating processes and procedures, hospitals will be required to improve or reconfigure facilities for ventilation, install new equipment for sterility and ensure employee protections.

The California Society for Healthcare Engineering encourages hospitals to participate in the Energy to Care program, sponsored by the American Society for Healthcare Engineering (ASHE). Last year, 43 facilities in California committed to saving energy through the program, which helps health facilities measure their energy use using a robust dashboard and offers recognition for efficiency accomplishments. This year, hospitals are encouraged to maximize their energy savings by participating in the program’s Energy Gold Rush Challenge Campaign. More information is available in the attached bulletin.

ASHE also provides a sustainability roadmap for hospitals seeking to reduce energy use, waste and costs. In recognition for its work, ASHE has been named a 2017 ENERGY STAR Partner of the Year – Energy Efficiency Program Delivery Award winner.

About

Through the Office of the Assistant Secretary for Preparedness and Response, Office of Preparedness and Emergency Operations, Hospital Preparedness Program (HPP) grant, CHA has created a web site specifically devoted to Emergency Preparedness at www.calhospitalprepare.org.

CHA recently redesigned its hospital disaster preparedness website, www.calhospitalprepare.org, to help providers find the tools they need more quickly and efficiently. The site features information on preparedness training and exercises, upcoming events, planning topics and health care emergency management, as well as timely articles and reports. These resources will help California hospitals plan, prepare for and respond to the needs of victims of natural or man-made disasters, bioterrorism and other public health emergencies.

CHA’s Disaster Planning for California Hospitals Conference, to be held Sept. 18-20 in Sacramento, will provide an inside look at the recent shooting at the Bronx Lebanon Hospital Center in New York. Sridhar S. Chilimuri, MD, FACP, AGAF, physician-in-chief and chairman, Department of Medicine for Bronx Lebanon Hospital Center, will recount how hospital staff performed heroically under duress, saving all six of the wounded. “Timely action is what saved lives that day,” Chilimuri said. “Many of our victims had horrendous injuries from assault weapons at a close range, but the team that worked on them kept all of them alive.”

Other conference highlights include keynote sessions on the 2017 Oroville Dam crisis and emerging infectious diseases; a pre-conference workshop on regulatory, accreditation and grant requirements for emergency management; 19 different breakout sessions; an exhibit show and more. The conference is the largest statewide program for hospital emergency preparedness professionals. The full agenda as well as registration and hotel information is available at www.calhospital.org/disaster-planning. The deadline for discounted registration and hotel reservations is Aug. 18.

A new report from the American Hospital Association finds that hospitals and health systems spent an estimated $2.7 billion addressing community violence in 2016 and highlights significant work hospitals are undertaking to mitigate violence in the workplace and the community.

The California Department of Public Health (CDPH) reminds health care providers that, during the hot summer months, they should monitor the heat situation and take appropriate action to protect vulnerable populations. The National Weather Service has issued excessive heat watches and warnings for portions of Northern California over the next several days. Providers are encouraged to refer to CDPH’s Crisis and Emergency Risk Communication Toolkit for public information materials, including an extreme heat press release template. At this time, no local emergency operations centers have been activated; however, local health departments are asked to advise CDPH and the California Emergency Medical Services Authority of any heat-related health impacts.

The Centers for Disease Control and Prevention has released the attached manual addressing supply chain disaster preparedness, developed in response to a 2013 survey that found more information was needed on coordinating with local or state governments during a disaster and determining the roles the federal government will play in a disaster. Targeted at health care supply chain managers and health care facility emergency managers, the manual illustrates that disaster preparation is a coordinated effort involving the entire community. Other users of the manual include health care supply distributors, health care administrators, clinicians, and government and nonprofit professionals involved in disaster planning and response.

CHA assists hospital environmental health and safety (EH&S) officers and other hospital personnel regarding compliance with the many — and frequently overlapping — state and federal EH&S requirements, including those related to managing medical, hazardous and low-level radioactive waste. CHA also monitors EH&S legislation and regulation on behalf of hospitals and acts as their liaison with government agencies.

The Centers for Medicare and Medicaid Services (CMS) has issued the attached memo reminding health care providers of requirements for fire and smoke door annual testing. Under the 2012 edition of the National Fire Protection Association (NFPA) Life Safety Code, facilities must meet certain requirements for the maintenance, inspection and testing of fire doors and smoke doors in certain certified health care facilities. In health care occupancies, annual inspection and testing in accordance with the 2010 NFPA 80 is required for all fire door assemblies. Although non-rated doors, including corridor doors to patient care rooms and smoke barrier doors, are not subject to those requirements, they should still be routinely inspected as part of the facility maintenance program. Facilities were originally required to comply prior to July 6, 2017. However, due to reported misunderstanding of the requirements, CMS has extended the deadline for full compliance to Jan. 1, 2018.

The Centers for Disease Control and Prevention (CDC) has released a new Vital Signs report highlighting patients’ risks of exposure to Legionella bacteria in health care facilities, including hospitals and long-term care facilities. According to the report, one in four people who contract Legionnaires’ disease as a health care-associated infection will die. Effective water management is key to preventing health care-associated outbreaks. The CDC has made available resources and tools to assist providers in reducing the threat from this bacteria. The American Society of Healthcare Engineers has also released tools to assist its members in managing water systems. Additionally, the Centers for Medicare & Medicaid Services has released the attached guidance providing more information about infections, tips for prevention and expectations of health care facilities.

The California Air Pollution Control Officers Association has developed the attached draft guidelines updating procedures for public notification of air pollution risks and incorporating advances in the field of risk assessment. Current law requires regulated facilities, including hospitals (under certain conditions), to report the types and quantities of toxic air pollutants they routinely emit. For hospitals, this includes emissions from back-up diesel generators. The law, known as the “Hot Spots” Act, also requires air quality management districts (AQMDs) to determine which facilities must conduct health risk assessments using the California Air Resources Board’s Emission Inventory Criteria and Guidelines. The draft guidelines, developed with assistance from the California Office of Environmental Health Hazard Assessment and the California Air Resources Board, are intended to be used by local districts in evaluating their Hot Spots programs. Hospitals should work with local AQMDs to learn how these guidelines will be implemented at the district level and whether their district will also update its pollution emission standards.

In partnership with the Oak Ridge Institute for Science and Education (ORISE), the Radiation Emergency Assistance Center/Training Site (REAC/TS) provides emergency response advice and consultation for the National Nuclear Security Administration’s Office of Emergency Response as well as a number of continuing education classes geared toward health care professionals. Medical personnel, emergency planners, public health professionals and others will learn about the medical management of radiological/nuclear incidents through didactic and hands-on education. An additional course accredited by the American Academy of Health Physics is available for health physicists, medical physicists, radiation safety officers and nuclear medicine personnel.

The REAC/TS course brochure for October 2016 – September 2017 is available on the ORISE website, and online registration is now available. Courses are held at the REAC/TS Facility in Oak Ridge, TN. REAC/TS is also available to conduct one or two-day training programs at hospital locations. For more information, contact reacts@orau.org or call (865) 576-3131.

Hospital finance is complicated, and California hospitals operate in a challenging environment. Hospital executives are faced with the task of developing financial strategies that contain costs yet allow for the provision of health care to the state’s large uninsured population.

Expand the Independence at Home program, which allows seniors to receive specialized care at home

Improve flexibility in the Medicare Advantage program by allowing plans to tailor coordination and benefits to specific patient groups, permanently extending special needs plans and expanding supplemental benefits

Allow certain accountable care organizations to use their own money to help patients afford primary care services, and provide the option to assign beneficiaries prospectively rather than retrospectively

Expand the use and flexibility of telehealth services

A one-page summary and a section-by-section summary of the bill are attached. The bill was previously introduced in December 2016 and remains largely unchanged.

The Department of Health Care Services (DHCS) has announced that the current Medi-Cal fiscal intermediary for its fee-for-service system, Xerox State Healthcare, LLC, has been rebranded to Conduent State Healthcare, LLC. This shift, caused by the entity’s separation from its parent company, reflects its shift to a new independent, publicly traded company called Conduent Incorporated. The rebranding process began Jan. 3, when the separation was finalized.

It is essential for Medi-Cal-enrolled providers, beneficiaries and stakeholders to know that, effective Jan. 3, 2017, correspondence bearing the name Conduent may be related to Medi-Cal.

To stay informed about any changes occurring within Medi-Cal, enrolled providers, beneficiaries and stakeholders should open and read all information sent from DHCS, Xerox or Conduent. More information is available on the DHCS website.

Hospitals can play an important role in reducing the number of uninsured through the Hospital Presumptive Eligibility (HPE) program. The HPE program will allow all hospital Medi-Cal providers — including any clinic on a hospital’s license — to provide potentially-eligible individuals with temporary, full-scope Medi-Cal benefits.

Our nation’s health care system has entered a new era with the enactment of federal health care reform. This landmark legislation is resulting in many changes in how health care is financed and delivered for years to come. For nearly two decades, CHA has been at the forefront in advocating for meaningful health care reform — and we will continue to help shape the future of hospital care far into the future. CHA’s vision of an “optimally healthy society” is now a reality within reach.

This section provides materials to help hospitals understand and comply with the law, plan for the future, and communicate with their patients and communities about the impacts of health care reform.

Covered California has released a new analysis showing the consequences California faces if federal policies are changed – specifically, if funding for cost-sharing reduction reimbursements is ended and the individual shared responsibility payment is not enforced for consumers who choose not to purchase coverage. According to the report, Covered California’s premiums could rise 28 to 49 percent in 2018, and changes to federal policy could result in up to 340,000 consumers losing coverage. This would lead to increased federal spending, anticipated to be in the billions of dollars. More information is available in Covered California’s press release.

Last week, the Centers for Medicare & Medicaid Services (CMS) issued the Notice of Benefit and Payment Parameters final rule and the final Annual Letter to Issuers for 2018 in the Federally Facilitated Marketplaces. The final rule establishes standards for issuers and each health insurance marketplace, generally for plan years that begin on or after Jan. 1, 2018. The policies in the final rule include updates to the risk adjustment program and to eligibility, enrollment and benefits, as well as other changes that aim to streamline the marketplace consumer experience and strengthen the marketplaces’ individual and small group markets as a whole. The final rule builds on other actions CMS has taken to strengthen the marketplaces in recent weeks and months, including an interim final rule addressing concerns about third-party premium payments and a pilot that will test whether pre-enrollment verification of special enrollment periods strengthens the marketplace risk pool while maintaining access to coverage.

The California HealthCare Foundation has released a report that examines efforts to improve care quality, coordination and costs through provider collaborations. The report acknowledges that California providers — many of them CHA members — have been particularly active in developing collaborations among themselves and with commercial health plans in response to the Affordable Care Act. Many of these partnerships have been driven by key market factors characteristic of many California communities — most notably, the presence of large providers experienced in managing financial risk for patient care, as well as competitive pressure on both insurers and providers. Most of these initiatives aim to slow the growth of health care spending and improve the coordination and quality of patient care.

The report describes integration efforts that have proliferated in California since 2013, highlights leading examples from the seven regions studied, discusses collaborators’ key goals and strategies, and explores how market conditions spurred each major type of partnership and influenced their structure.

Working with colleagues in New York and New Hampshire, CHA asked members of the California congressional delegation to sign a letter addressed to Secretary of Health and Human Services Sylvia Burwell, urging reform of the current liver distribution methodology. A total of 68 members of the U.S. House of Representatives, including 27 from California, signed the letter.

The current methodology — which is based on 58 local donation service areas (DSAs) of varying size, density and health — creates large disparities in access to liver transplantation between patients in different regions of the country. To increase fairness of liver allocation, the signatories of the letter recommend that the Department of Health and Human Services adopt the United Network for Organ Sharing (UNOS) committee’s proposal to condense the 58 DSAs to between four and eight districts. The proposal also specifies that each district would contain at least six liver transplant centers that support a maximum median transplant-volume-weighted transport time between DSAs of no more than three hours. The letter echoes CHA’s beliefs, outlined in a comment letter to UNOS last week in support of their recommendations.

CHA has submitted the attached comment letter to the United Network for Organ Sharing (UNOS), supporting the Liver and Intestinal Organ Transplantation Committee’s recommendations to reduce geographic and economic disparities in access to liver transplantation. CHA believes the current liver allocation methodology, which operates under 58 local donation service areas (DSAs), is responsible for the unfair disparities that deprive many Californians of life-saving liver transplants.

In the letter, CHA comments on the high barriers Californians face in receiving liver transplantation compared with patients in other areas of the nation, who are arbitrarily favored due to the unbalanced structure of the 58 DSAs. In addition, because Californians suffer from a higher incidence of liver disease, patients wait longer, receive livers when they are sicker and die at substantially higher rates.

CHA supports the capture and availability of secure patient-care data through the use of health information technology (HIT) across the continuum of care. CHA believes HIT serves as a tool to enhance patient safety, promote information sharing for preventative health services and reduce health care costs.

Hospitals face a number of challenges with HIT such as security and interoperability. The development of industry standards is crucial to successful interoperability and the safe and effective exchange of patient data. Certification of vendor systems, for example, involves compliance with industry-accepted data and technical standards.

The Department of Health Care Services (DHCS) has changed an eligibility rule for hospitals applying to the program year 2016 Medi-Cal Electronic Health Record Incentive Program for the first time. Previously, DHCS required hospitals to submit cost report data for a continuous 12-month period ending before the start of the federal fiscal year (Oct. 1-Sept. 30) that serves as the program year for the Medi-Cal EHR Incentive Program. Under the recent change, hospitals will be able to submit data for the 12-month period before the fiscal year ends. In addition, hospitals with a new CCN must reapply to the program.

Hospitals are reminded that program year 2016 marks the last opportunity to start the program; applications from hospitals that have not successfully participated in the 2016 program will not be accepted for 2017 and subsequent years. Applications are due May 2. For more information, visit http://medi-cal.ehr.ca.gov/ or call (916) 552-9181.

The U.S. Government Accountability Office (GAO) recently issued a report that reviewed the state of patients’ electronic access to their health information. The report found that relatively few patients electronically access their health information when offered the ability to do so and that – while patients generally find access beneficial — there are limitations, such as the inability to aggregate health information from multiple providers into a single record. The GAO recommended that the Department of Health and Human Services develop performance measures to assess outcomes of efforts related to patients’ electronic access to longitudinal health information, and use the information from these measures to help achieve program goals. The full report is available on the GAO website.

The Office of the National Coordinator (ONC) for Health Information Technology has released its final rule implementing new requirements under the ONC Health IT Certification program. The final rule creates a regulatory framework for ONC’s direct review of health information technology certified under the program, including requiring the correction of non-conformities found in health IT certified under the program and suspending and terminating certifications issued to complete EHRs and health IT modules. The final rule also sets forth processes for ONC to authorize and oversee accredited testing laboratories and includes provisions for expanded public availability of certified health IT surveillance results. The regulations will take effect 60 days after publication in the Federal Register.

There’s a lot of buzz around the new HIPAA/HITECH final rule, and hospitals are moving quickly to review and understand the new federal regulations. But, California has its own set of laws to consider that are sometimes more stringent. So, which laws do you need to follow?

California hospitals and health systems employ more than half a million people — from entry-level positions to senior executives. Many health care human resources (HR) departments are responsible for a wide range of issues, such as recruitment, staffing, compensation, benefits, labor/employee relations and employee health. Navigating the complex regulatory environment, while monitoring how it applies to HR in the health care setting, can be a challenging and dynamic task.

Representing hospitals and health systems in California, CHA provides leadership in HR policy on state and federal levels. In addition, CHA advocates on behalf of hospitals and health systems before the federal and state legislatures, federal and state administrative agencies and the public. CHA also provides educational opportunities, such as the annual Labor & Employment Law seminar, to help hospital leaders sharpen their skills and knowledge in health care HR. CHA members also participate on an HR executive e-mail list and receive periodic informational memoranda.

The Service Employees International Union – United Healthcare Workers West today filed a ballot initiative — the Kidney Dialysis Patient Protection Act — with the attorney general for the 2018 General Election.

The initiative would establish minimum staffing requirements for nurses, hemodialysis technicians, social workers and registered dietitians in chronic dialysis clinics. In addition, it would create a minimum transition time between patients and limit charges to 115 percent of “reasonable treatment cost,” as defined in the initiative. The initiative would also establish reporting requirements and penalties for violations.

Although the initiative aims to impose these provisions on for-profit dialysis corporations, some hospitals that operate chronic dialysis clinics may also be impacted. The attorney general will prepare and issue a title and summary in October 2017, which can be used to circulate the petition for signatures. The initiative’s sponsors must collect and submit an estimated 366,000 verified signatures in April 2018 to qualify the initiative for the Nov. 6, 2018, General Election.

The Office of Administrative Law (OAL) has approved new regulations, adopted by the California Fair Employment and Housing Council (FEHC), concerning employers’ use of criminal background information when making employment decisions. The regulations, which take effect July 1, require employers to demonstrate that any criminal history information sought is job-related and consistent with a business need. To meet this obligation, employers may either 1) conduct an individual assessment of circumstances and qualifications of applicants excluded by the conviction screen and determine whether an exception is warranted, or 2) demonstrate that its conviction disqualification policy, though not based on individual assessment, nonetheless properly distinguishes between those who do and do not pose an acceptable level of risk.

Any policy that is not based on individual assessment and is seven or more years old will be presumed not to meet the standards of the new regulations; employers must rebut this presumption proactively. Additionally, prior to taking any adverse action, employers who obtain criminal information from a source other than the applicant must notify the individual and provide him or her an opportunity to challenge the information’s accuracy.

CHA’s annual Hospital Employee Safety and Workers’ Compensation Seminar will be held March 22 in Sacramento and March 30 in Costa Mesa. Make plans now to attend the hospital-focused seminar that offers practical guidance and comprehensive information to improve and manage employee safety and workers’ compensation programs. The one-day, members-only program includes sessions on Cal/OSHA’s workplace violence prevention regulation, managing employee leaves of absence, using data and metrics to improve employee programs, employer leading practices and more. A detailed agenda and program registration will be available later this month.

The Board of Registered Nursing (BRN) has determined that certain registered nurses do not have both Department of Justice (DOJ) and Federal Bureau of Investigation (FBI) fingerprint results on file with the BRN. LiveScan testing incorporates both DOJ and FBI requirements; however, if the LiveScan technology did not produce clear results or an outdated method of fingerprinting was used, the RN may not have acceptable fingerprints on file.

The BRN is working to contact all affected RNs via mail and/or email with instructions. To avoid potential delays in license renewal or other action, RNs should read the information carefully and respond accordingly. In most cases, RNs will be required to submit fingerprints within 60 days of notification or risk citation, fines or referral to the Attorney General’s office for possible disciplinary action.

Hospital human resources and legal professionals who attend CHA’s annual Labor and Employment Law Seminar will learn practical, useful information to help successfully structure policies, procedures and programs that encompass new developments and ensure compliance. Set for Oct. 19 in Sacramento and Oct. 26 in Los Angeles, the seminar opens with an analysis of wage and hour case law, including meal and rest period developments and calculating overtime. Attendees will also learn steps to avoid wage and hour pitfalls related to alternative work schedules, joint employer issues and liability, and more.

CHA’s legal department advocates vigorously before the courts on behalf of California hospitals, both as a party in litigation and as amicus curiae in important appellate cases. In addition, the CHA legal department prepares legal memoranda and manuals to help hospitals understand and comply with state and federal laws. The CHA legal department also supports CHA staff in their advocacy efforts before the state legislature and regulatory agencies.

Last week the California Court of Appeals ruled in Julian v. Mission Community Hospital, finding that California’s involuntary mental health evaluation and treatment laws do not confer a private cause of action. This means that a patient cannot sue a hospital or physician for involuntarily detaining, evaluating or treating him or her. The court held that only administrative agencies — such as the California Department of Public Health or the Medical Board of California — can enforce these laws against a hospital or physicians. The court also held that the hospital and physicians were not state actors under civil rights laws and, therefore, could not be liable for violating the plaintiff’s rights under the federal and California constitutions.

The case was certified for publication, which means that it may be cited as precedent in future lawsuits. It is unknown at this time whether the plaintiff will ask the California Supreme Court to review the case. The court’s decision is attached.

CHA is pleased to announce the 2017 Consent Manual is now available. Updated to reflect changes to state and federal consent law through January 2017, the Consent Manual explains the law and what hospitals need to do to comply. As a service to members, one complimentary copy of this acclaimed publication is being sent to each member hospital and system CEO this week.

The Consent Manual is the most comprehensive resource available on consent for medical treatment, covering situations involving minors, mental health, end-of-life issues and advance health care directives, patients’ rights, privacy basics, reporting requirements and related health care law. It is designed to help keep hospital executives abreast of the law and provide answers to difficult questions faced by staff every day.

The Food and Drug Administration (FDA) has publicly disclosed multiple hospital violations of the mandatory reporting requirement when a medical device may have caused harm. Hospitals and other health care providers (“device user facilities”) must report to the FDA any event that reasonably suggests that a medical device has or may have caused or contributed to a death or serious injury of a patient. This includes user error; improper or inadequate design, manufacture or labeling; or any other cause of harm related to a device, as well as device malfunction.

The End of Life Option Act is one of the most important bills the Governor signed into law this year. Individuals who have a terminal illness and meet certain qualifications may now ask their physician for prescription medication to end their life. The law is complicated and not without controversy.

California and federal laws give hospital patients many rights. Hospitals must notify patients of these rights by giving patients a handout and/or by putting posters up in the hospital.

CHA has developed a sample handout that hospitals may use to notify patients of their rights under state hospital licensing regulations, the Medicare Conditions of Participation, and The Joint Commission.

Effective Jan. 1, a hospital’s internal child abuse reporting policy may not direct employees to allow their supervisor to file or process a mandated report under any circumstances. The law was enacted because of concerns that supervisors at private foster family agencies had impeded social workers and teachers from making reports when they suspected child abuse.

This guidebook guides you through the basic principles of patient consent for health care treatment. In clear, simple terms this publication explains why and when consent is necessary, who may give consent, how consent for minors is different, and procedures that require special consent. It also describes the hospital’s obligations when dealing with complicated issues such as advance health care directives, California’s POLST form, refusal of treatment, and end-of-life decisions, including California’s End of Life Option Act .

From basic principles to specific procedures, the Consent Manual is your one-stop resource for all legal requirements related to patient consent for medical treatment, release of medical information, reporting requirements and more. Learn exactly what the law requires and what you need to do to comply.

The End of Life Option Act is one of the most important bills the Governor signed into law this year. Individuals who have a terminal illness and meet certain qualifications may now ask their physician for prescription medication to end their life. The law is complicated and not without controversy.

Overview

A major transformation is underway in health care to enhance patient care quality, access and experience, and reduce costs. Because population health management (PHM) is the direction in which health care is moving, the California Hospital Association is pleased to provide member hospitals with comprehensive and substantive podcasts and webinar recordings designed to enhance the knowledge and skills needed to succeed under a PHM construct.

Master PHM
Based on CHA’s webinar series, Population Health Management: A comprehensive, five-part program for hospital leaders, the podcasts and recordings offer critical information for executives and professionals in a wide range of organizations. Five key areas are presented:

Frequent studies in recent years have argued that health care errors are a significant cause of morbidity and mortality in the United States. A number of organizations, such as the Institute of Medicine (IOM), recommend that health care errors and adverse events be reported in a systemic manner.

This increasing attention on the quality of patient care in hospitals has renewed CHA’s commitment to assist with improving the quality of patient care in every California hospital. In 2006, the CHA Board of Trustees endorsed the CHA Quality and Patient Safety Plan of 2006.

The California Department of Health Care Services (DHCS) has completed its review of the competitive application process for distributing funds to narcotic treatment program (NTP) providers for opioid treatment, consistent with the federal grants issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) – State Targeted Response Opioid Grant Program. The 21st Century Cures Act authorized $485 million in funding to be issued by the U.S. Department of Health and Human Services to address opioid abuse; California has been allocated $90 million over two years to assist with its Medication Assisted Treatment (MAT) Expansion.

The project strategically focuses on expanding access to populations with limited MAT availability, including rural areas and American Indian and Native Alaskan tribal communities, and increasing statewide access to buprenorphine. The grant focuses on two projects: the California Hub and Spoke System (CA H&SS) and the Tribal MAT Project. DHCS received 62 applications from providers to operate a hub and spoke system and selected 19 to fund across the state. The total amount allocated for the CA H&SS is $78 million for the two-year period. The remaining grant funds will be used to fund the Tribal MAT Project and training conducted by UCLA and the California Society of Addiction Medicine.

The California Department of Public Health’s Center for Health Care Quality will host its semi-annual stakeholder forum on Aug. 17 from 1-2:30 p.m. (PT). The forum is scheduled to provide updates on Licensing & Certification Program activities, including a performance metrics update, Hubbert recommendation updates, and discussion of 3.5 staff direct care hours regulations as well as the Quality Accountability Supplemental Payment Program. The session will also include time for general questions and answers. More information is available on the Stakeholder Forum web page.

Screen contacts of the patients to identify C.auris colonization. Because patients colonized with C. auris can be a source of C. auris transmission, these patients should be managed using the same infection control measures as for those with C. auris infection.

Health care facilities should report possible C. auris, or isolates of C. haemulonii and Candida spp. that cannot be identified after routine testing, to their local health department and the Healthcare-Associated Infections (HAI) Program at HAIProgram@cdph.ca.gov. The HAI Program can assist with infection control guidance and coordination of C. auris identification testing at the CDPH Microbial Diseases Laboratory. For questions about available fungal diagnostic testing services, contact Dr. Linlin Li at Linlin.Li@cdph.ca.gov.

The Hospital Quality Institute (HQI) is pleased to announce the launch of QuietNight™, a next generation mobile tool designed to measure noise in hospital environments and provide real-time feedback.

Excessive noise negatively impacts patient rest and healing. According to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data, reducing noise has been a steady challenge for California hospitals. Accurate to within -/+ 1 decibel, QuietNight rapidly measures the sound floor in any environment and quantifies opportunities for noise mitigation based on deviation from recommended levels. The app registers and tracks baseline as well as startle noise and provides actionable guidance when noise levels are moving to unacceptable levels. It also integrates HQI’s Journey to a Quiet Night toolkit, which contains best practices for noise reduction, abatement and maintaining a quiet, therapeutic environment.

California hospitals are currently ranked in the bottom tier nationwide on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. In its examination of methods to improve these scores, the Hospital Quality Institute (HQI) analytics team found that a percent increase in response rate is predictive of a one-half percent increase in overall mean score. Therefore, HQI has set a target for hospitals to increase their overall response rate by at least 3 percent, which would advance statewide performance ratings to a score of 68 — and out of the bottom quartile. In California, response rates range from 8 to 60 percent. HQI urges hospitals with response rates of less than 25 percent to consider the following evidence-based recommendations:

California hospitals’ revenue stream is critical to their overall mission of providing care and cures in the communities they serve. While over half of hospitals’ revenue, nearly $30 billion a year, is derived from government-funded programs, including Medicare, Medi-Cal, Healthy Families and county indigent programs – Private Insurance revenues are also significant.

CHA believes that hospitals should be reimbursed adequately to cover the cost of care for enrollees. CHA also believes every Californian who is eligible should be enrolled in the appropriate federal, state or local governmental program. Hospitals and private payers should not be responsible to pay for government underpayments. CHA dedicates many resources to advocate for fair government reimbursement. CHA DataSuite is an information-based toolset, available only to CHA members, that helps hospitals analyze government reimbursement changes, and the potential impact of regulatory and legislative actions on hospitals.

The Centers for Medicare & Medicaid Services (CMS) has released two new forms for providers’ use. The first form relates to electronic funds transfers, and is required to be completed by all Medicare Part A providers who are enrolling or revalidating, or who have changes to their employer identification number, pay-to address or legal business same. The second form released by CMS is an updated Advance Beneficiary Notice of Noncoverage; providers were required to begin using this form June 21. Any new notices submitted on the old form after June 21 will be considered invalid, and will result in provider liability if Medicare denies the claim.

Noridian, the Medicare administrative contractor for California, encourages providers to submit redetermination requests and associated documentation through its online portal, a faster option that also prevents requests from being dismissed for lack of signature. Additionally, providers may access decision letters immediately through the portal.

Noridian also announced that HMS Federal Solutions launched the new Region 4 recovery audit website, which provides information providers may use to prepare if selected as part of any new issue reviews.

The Centers for Medicare & Medicaid Services (CMS) has issued the attached proposed rules updating the outpatient prospective payment system (OPPS) and physician fee schedule (PFS) for calendar year 2018. Fact sheets for both the OPPS and PFS proposed rules are also available. CHA is currently analyzing the proposed rules and will provide members with additional information in CHA News tomorrow.

The Division of Workers’ Compensation (DWC) has posted an order adjusting the hospital outpatient departments and ambulatory surgical centers section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by the California Labor Code. Effective for services rendered on or after July 1, the order adopts the following changes:

In its June report the commission continues its work, required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, evaluating the feasibility of a unified prospective payment system (PPS) spanning post-acute care (PAC) settings (e.g., skilled-nursing facility, inpatient rehabilitation facility, long-term care hospital and home health agency). After determining a unified PPS is feasible in its 2016 report, the commission studied three implementation issues: a transition period with blended setting-specific and unified PPS rates, appropriate levels of aggregate PAC payments, and ways to address ongoing refinements to the system after implementation. MedPAC recommends that a unified PAC PPS be implemented beginning in 2021 with a three-year transition, and that aggregate payments should be reduced by 5 percent.

Amber Ott represents members’ financial interests related to Medicare, Medi-Cal, commercial payers and other government entities. She is responsible for providing advocacy and support on financial and reimbursement issues affecting California hospitals and health systems, and represents CHA with state agencies and other stakeholders where hospital finance and technical knowledge is needed.

Amber is also involved with the development and implementation of the hospital fee and other financing programs.

California hospitals are concerned about the need for an adequate supply of highly skilled health professionals to meet the demands for health care services now and in the future. Numerous studies have been completed that validate the need to address critical health professional shortages in nursing and the allied health occupations. However, efforts to implement recommended strategies have been hindered by a lack of a coordinated statewide effort involving health employers, as well as other necessary partners.

In response to the need for focus on this issue and the need for statewide solutions, CHA established the CHA Workforce Committee in 2007. Members of the committee include a broad cross-section of California’s hospitals, both urban and rural, and also represent the various geographic regions of the state. The committee has been focused primarily on allied health professional shortages, but in 2013 broadened its mission and focus to include supporting various statewide nursing and physician shortage initiatives. The committee recognizes that current challenges in the area of health workforce will be exacerbated by an aging population and implementation of the Affordable Care Act and is dedicated to working as a group and with other stakeholders to develop and implement solutions that will address the numerous barriers that constrict the supply of health care professionals in California.

The Behavioral Health Workforce Research Center has released two studies to help inform workforce development and planning, as related to the prevention and treatment of mental health and substance use disorders. The first study found that care integration appears to be most effectively implemented in organizations that foster a strong culture of collaboration, including employee engagement through orientation and training programs. Recognizing that a diverse workforce contributes to greater patient satisfaction, the second study seeks to identify organizational barriers to recruiting and retaining behavioral health workers representing racial, ethnic and sexuality minority groups. Specific factors include work location, organizational mission, job security and flexible work schedules affect recruitment and retention.

Established in 1973 to increase the number of family physicians serving Californians, the program encourages universities and primary care health professionals to provide health care in medically underserved areas by financially supporting primary care and family practice residency programs in hospital and health care settings throughout California. It does not provide funding to individual students.

The CHA Workforce Committee has long advocated for the need to develop industry specific “soft skills” training that can be embedded in health professions training programs, as well as used by employers with their existing workforce. Critical skills such as problem solving, teamwork, professionalism, ethics, compassion and communication are necessary for health professionals and are central to patient-centered care, regardless of an employee’s position in the health care setting.

The American Hospital Association’s 2016 Committee on Performance Improvement has issued the attached report to help hospital and health system leaders align the skills and abilities of their organization’s current workforce with anticipated needs as health care continues to change. CHA staff served on the special subcommittee that developed the report, and the CHA Workforce Committee’s recommendations are reflected in the key messages.

The report includes a tool to help initiate strategic workforce conversations, as well as specific recommendations and examples from hospital leaders and experts in the field.

“There is a critical need to elevate the discussion about workforce planning and development so that it becomes part of a comprehensive strategic plan for hospitals and systems and not just an issue to respond to in a crisis situation,” the report notes. “Current employee shortages, an older health care workforce nearing retirement coupled with the aging patient population, the changing health care delivery system, and limited access to behavioral health services all align to make workforce planning an immediate priority.”

The Health Careers Training Program, administered by the Office of Statewide Health Planning and Development’s Health Workforce Development Division, is now accepting applications for its Mini Grant program. The program awards up to $15,000 to cover a variety of activities, such as health career conferences, workshops and health career exploration to underrepresented and/or economically disadvantaged students who wish to pursue careers in the health industry. Public and private nonprofit, as well as private for-profit entities, including hospitals, are eligible to apply. The application deadline is March 1. A technical assistance webinar will be held for prospective applicants on Feb. 8 from 2-3 p.m. (PT). For more information, visit the program website.